Psychotropic Medications and Weight Management
Depression is one of the major public-health issues that may fall under the radar of registered
dietitians. When looking for news that may affect the dietetics field, the topic of depression may
not spark much of an interest. It is a disease for which only food-related symptoms may exist.
Unlike diabetes, hypertension, or kidney disease, you cannot look for strong clinical markers.
However, the Centers for Disease Control and Prevention recently reported that antidepressants
have become the most commonly prescribed drugs in the United States for adults 20−59 years of
age.
More and more patients seen by registered dietitians (RDs) are treated with psychotropic
medications. It is imperative that RDs familiarize themselves with these medications, because
their impact may contribute to the morbidity of those under their care.
Long-term use of antidepressants is associated with weight gain. The several classes of
psychotropic medications have differing mechanisms of action, but are associated with appetite
stimulation and/or decreased metabolic function with the outcome of weight gain. The categories
and their descriptions follow.
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs inhibit the reuptake of serotonin, a neurotransmitter. Serotonin stays in the synaptic gap
between two neurons longer and is sometimes recognized repeatedly by the receptors of the
recipient cell, stimulating it. SSRIs may increase or decrease basal metabolic rate, regardless of
caloric intake. They also may affect hormonal changes and increase appetite. Many reported
symptoms of patients using SSRIs are associated with diabetes, including weakness, hunger,
headaches, and hypoglycemia.
SSRIs include:
 Celexa® (citalopram)
 Prozac® (fluoxetine)
 Luvox® (fluvoxamine)
 Paxil® (paroxetine)
 Zoloft® (sertraline)
Tricyclic antidepressants (TCAs)
It is poorly understood how TCAs work, but it is believed they inhibit the reuptake of the
neurotransmitters norepinephrine, dopamine, or serotonin by nerve cells. Drugs in this class are
associated with metabolic slowing and carbohydrate cravings. Weight gain linked to these
medications may make it harder for diabetics to control their blood sugar levels.
Common TCAs include:
 Elavil® (amitriptyline)
 Asendin® (amoxapine)
 Anafranil® (clomipramine)
 Norpramin®, Pertofrane® (desipramine)
 Adapin®, Sinequan® (doxepin)
 Janimine®, Tofranil® (imipramine)
 Aventyl®, Pamelor® (nortriptyline)
 Vivactil® (protriptyline)
 Rhotrimine®, Surmontil® (trimipramine)
Monoamine oxidase inhibitors (MAOIs)
MAOIs act by inhibiting the activity of monoamine oxidase, preventing the breakdown of
monoamine neurotransmitters and so increasing the available stores. Dietitians probably are well
trained and well versed in the dietary restrictions and recommendations of patients on this class
of drugs. However, people display varying tolerances to food and drug interactions. Similar to
TCAs, MAOIs may slow down metabolism and increase carbohydrate cravings.
Common MAOIs include:
 Marplan® (isocarboxazid)
 Nardil® (phenelzine)
 Parnate® (tranylcypromine)
Having an understanding of antidepressants and psychotropic medications is key for treating
weight gain. Because weight gain is associated with long-term use of antidepressants, clients
may report an extensive asymptomatic history with a medication. Weight gain and appetite
stimulation may come only with a cumulative effect.
It is the role of the RD to:
 Educate patients to document their weight at the initiation and discontinuation of an
antidepressant
 Teach skills so that patients can maintain food logs that include hunger scales
 Track labs for glucose control
Researchers are beginning to understand mental illnesses and treatments for depression, but still
have a long way to go. Comorbidities and side effects associated with the current approaches for
treatment in depression affect the dietetics field. In working with those on SSRIs, TCAs, or
MAOIs, RDs will need to individualize strategies and treatment plans that incorporate
management of the weight-gain side effects often seen with many of the current psychotropic
medications.
References and recommended readings
Centers for Disease Control and Prevention. Therapeutic drug use. Available at:
http://www.cdc.gov/nchs/fastats/drugs.htm. Accessed May 15, 2011.
Pi-Sunyer X, Aronne L, Bray G. Weight gain induced by psychotropic drugs. Obesity
Management. 2007;3:165-169.
Riley G. The relationship between weight gain and medications for depression and seizures.
Available at: http://www.netnutritionist.com/fa12.htm. Accessed May 15, 2011.
Ruetsch O, Viala A, Bardou H, Martin P, Vacheron MN. Psychotropic drugs induced weight
gain: a review of the literature concerning epidemiological data, mechanisms and management.
Encephale [article in French]. 2005;31(4 Pt 1):507-516.
Review Date 10-11
G-1716